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Cigna TotalCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna TotalCare (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna TotalCare (HMO D-SNP) in 2025, please refer to our full plan details page.
Cigna TotalCare (HMO D-SNP) is a HMO D-SNP plan offered by The Cigna Group available for enrollment in 2025 to people living in Texas. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Cigna TotalCare (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Cigna TotalCare (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Cigna TotalCare (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Cigna TotalCare (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Cigna TotalCare (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay for your prescriptions. For example, you will pay a $20 copay for preferred generic drugs, and a $100 copay for preferred brand drugs. Once your total drug costs reach $2,000, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Cigna TotalCare (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have no copay, while outpatient services, including many primary care visits, also have no copay. Emergency services and worldwide emergency coverage have a $140 copay. The plan also includes coverage for hearing, vision, and dental services, with specific limits on the types of hearing aids and eyewear. Additional benefits include coverage for ambulance services, home health services, and medical equipment. The plan also covers dialysis services with 20% coinsurance, and a quarterly allowance of $200 for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits with Cigna TotalCare (HMO D-SNP) include coverage for Inpatient Hospital-Acute with no copay, and Inpatient Hospital Psychiatric with a $320 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, are covered by the Cigna TotalCare (HMO D-SNP) plan, but individual and group sessions for outpatient substance abuse are not covered. Outpatient blood services include an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna TotalCare (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna TotalCare (HMO D-SNP), including both ground and air ambulance services. Ground ambulance services have a $100 copay, and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are limited to 50 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Cigna TotalCare (HMO D-SNP) plan. For Emergency Services, the copay is $140, and there is no coinsurance. For Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, the copay is $140. Urgently Needed Services have no copay or coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered with no coinsurance. Chiropractic Services, Mental Health Specialty Services, and Psychiatric Services are covered, but Individual and Group Sessions for Mental Health and Psychiatric Services, and Routine Chiropractic Care are not covered. Podiatry Services are not covered.
Preventive Services See details
The Cigna TotalCare (HMO D-SNP) plan covers various preventive services, including annual physical exams, health education, fitness benefits, and support for caregivers of enrollees. Some services, like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services and Other Preventive Services are covered, with a doctor referral required for Medicare-covered Barium Enemas.
Hearing Services See details
Hearing services include routine hearing exams, fitting and evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids (all types) are covered with a copay between $399 and $1800 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with one visit per year, and eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames) with a combined maximum of $375 per year, and eyeglass lenses and frames, each with one pair per year.
Dental Services See details
The Cigna TotalCare (HMO D-SNP) plan covers a range of dental services, including exams, X-rays, and cleanings, with a maximum annual benefit of $3,500. Orthodontic services, restorative services, and other services like endodontics are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The copay for Medicare Part B Insulin Drugs is $35, and the coinsurance ranges from 0% to 20% for all covered drugs.
Dialysis Services See details
Dialysis Services are covered under the Cigna TotalCare (HMO D-SNP) plan, requiring prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, and Prosthetics/Medical Supplies with no copay and 10% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Cigna TotalCare (HMO D-SNP) plan. Lab Services have no copay, while Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Cigna TotalCare (HMO D-SNP) plan with no copay and no coinsurance, but require authorization. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for covered services.
Skilled Nursing Facility (SNF) See details
The Cigna TotalCare (HMO D-SNP) plan covers Skilled Nursing Facility (SNF) services, but requires prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Cigna TotalCare (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit of $200 every three months. The plan also covers meal benefits for chronic illnesses or medical conditions requiring the enrollee to stay home. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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